ABSTRACT
A 56-year-old intoxicated female is transferred to the emergency room from an outside hospital 2 h after she was hit by a car at low speed. The patient was thrown to the ground, and the right front wheel of the car ran over her right lower extremity. The patient experienced no loss of consciousness. She is awake and alert, has no respiratory difficulties, the blood pressure is 126/82, and the heart rate is 78 bpm. On secondary survey, there is a swollen dislocated right knee and an obvious distal tibia fracture with bone protruding through a 20 cm × 10 cm skin defect (Figure 18.1). The right lower extremity is pulseless, pale, and insensate. A Betadine®-soaked dressing is placed over the open fracture, and the right lower extremity is immobilized. One gram of cephazolin is administered intravenously.
